title: Medial femoral condyle fracture as a complication of antegrade intramedullary nailing.
abstract: A 49-year-old man suffered a closed oblique fracture of the middle third of his left femur. Closed reduction and internal fixation by intramedullary (IM) nailing were performed. Per-operative fluoroscopic imaging and initial postoperative X-rays were judged normal and the patient followed the usual rehabilitation protocol. At 3-month follow-up the patient still demonstrated poor knee function and pain. A plain X-ray and a CT scan of the left knee revealed a displaced fracture of the medial femoral condyle. Analysis of the postoperative imaging suggests that the fracture occurred during the insertion of the IM nail. The nail possibly hit the Steinmann traction pin in the distal femur causing the medial condyle fracture. The patient was reoperated; open reduction and internal plate and screw fixation were performed with satisfactory clinical progress postoperatively. The description and illustration of this case is intended to make trauma surgeons aware of this rare but serious complication of IM femoral nailing.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Rue du Bugnon 1011, Lausanne, Switzerland. felixneumayer@yahoo.com
authors.forename: F
authors.initials: F
authors.lastname: Neumayer
authors.forename: C
authors.initials: C
authors.lastname: Löcherbach
authors.forename: J
authors.initials: J
authors.lastname: McManus
authors.forename: F
authors.initials: F
authors.lastname: Chevalley
mesh_terms: D001858:Bone Nails / Q000009:adverse effects*; D005264:Femoral Fractures / Q000209:etiology*; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged